HSCI 130: Final Exam Flashcards

1947

saskatchewan hospital

1972

medicine everywhere in Canada

1984

Canadian Health Act

$334 billion

the amount we spend on healthcare

43%

% of BC budget spent on healthcare

where do we spend our money? (3 main categories, answer in percentages)

14% drugs, 14% doctors, 25-30% hospitals (largest categories)
5-10% public health + prevention

Nunavut ($23.6k), Northwest Territories ($21.7k), Yukon Territories ($15.6k)

top 3 provinces higher than BC ($9,182)

Ontario ($8.2k), New Brunswick ($8.4k), Manitoba ($8.6k)

top 3 provinces lower than BC ($9,182)

explain the pacman argument: what is it, what is the challenge, what is the effect on society?

• pacman = healthcare eating resources; spending large budget on healthcare

• challenge = pie has shrunk, revenue has gone down

• effect on society

  • decreasing revenue = decreasing corporate taxes

  • people don’t want cuts

  • decreasing budget = healthcare takes up more % and cuts away at other %

HIV/AIDS is mostly in _______

sub-Saharan Africa

39 million people

people living with HIV

1.5 million people

children <15 living with HIV

most new TB cases are in ____________

South-East Asia

25%

world population with TB

5-10%

people with TB who become sick at some point

the highest per capita incidence of TB is in _____

Africa

10.6 million cases

new cases of TB (10.3m in 2021, 10m in 2020)

1.3 million people

people who died from TB

19% net reduction

global number of TB deaths (2015-2022)

11%

new cases of TB also with HIV

This construct describes the finding that immigrants to Canada arrive healthy and then see their health deteriorate

What is the healthy immigrant effect?

The name of this rock star who convinced Senator Jesse Helmes to change his position on AIDS funding

Who is Bono?

The people who truly have a disease but test negative on a particular test

What is a false negative?

By this year, all Canadian provinces had adopted Medicare

What is 1972?

This is the year of the establishment of the Canada Health Act

What is 1984?

In this type of study design, exposure is randomized

What are randomized control trials?

They neutralize pathogens and tag pathogens for destruction by the immune system

What are antibodies?

The materialist explanation that the higher number of health problems among lower SES groups is a result of stress

What is the differential exposure hypothesis?

HIV infects and kills these cells, thus rendering the entire immune system dysfunctional

What are CD4 t-cells?

Number of new cases / person time of observation

What is the formula for incidence rate?

NPHS (National Population Health Survey) data indicates this is the number one reason people seek formal health care in Canada

What is chronic pain?

This concept describes illness caused by medical intervention

What is iatrogenesis?

The type of study that helped epidemiologists discover that TSS was caused by tampons

What is a case control study?

These are the 5 principles of the Canada Health Act

Comprehensiveness	(NOT comprehension); requires that health insurance plans cover all necessary health services
Universality	All insured persons must be given care on uniform terms and conditions
Portability	The system follows you where you go; you can move/travel around Canada and your healthcare will follow you
Public Administration	Non-profit basis by a public authority accountable to the government and people
Accessibility	Without financial or other barriers; problem with Canada Health act is that “or other” is not defined

This hypothesis is focused on explaining why men are more likely to die from accidents

What is the risk taking hypothesis?

Virchow concluded that this as the primary cause of the 1848 typhus epidemic in Upper Silesia

What is a lack of democracy?

The idea that we need to understand an individual’s definition and understanding of a situation falls under this sociological paradigm

What is symbolic interactionism?

The proportion of a population who become diseased during a specific time period

What is cumulative incidence?

Antonovsky’s model that describes the factors that make populations healthy

What is the salutogenic model of health?

These highly cited studies in England demonstrated that there is a social gradient in health

What are the Whitehall studies?

Raphael’s term to describe macro-level factors like tax policies that indirectly influence health

What are vertical structures?

The famous epidemiologist who discovered the source of the 1854 Cholera outbreak

Who is John Snow?

This is the estimated number of British Columbians without a family doctor

What is 17-22%?

Medicare was born in this Canadian province

What is Saskatchewan?

8 concepts of health

• Normality (what is considered “normal health” in the population)

• Balance (balancing all aspects of life)

• Adaptability (able to deal with reasonable life challenges)

• Fitness (physical exercise)

• Absence of illness/disease

• Physical/emotional/social

• Resource for life (necessary to maintain throughout life course)

• Function (work, daily life)

5 aspects of the biomedical model

• Mind-Body Dualism = mind and body are separate, physical and psychological factors are separate; focus on biophysical factors

• Machine Metaphor = body is a machine (Western Science); body is made up of biophysical processes (e.g., genes)

• Physical Reductionism = understanding phenomena by breaking down parts of a whole; examine parts individually to gain understanding

• Specific Etiology = every disease has a cause; discovering causes allows us to intervene/provide treatment

  • With control (e.g., drug therapy)

  • By removal (e.g., surgery)

• Regimen/Control = fight/minimize disease through regimen and control

  • Assumption: we can disciple our bodies (e.g., eating, exercising, managing stress)

  • Individuals are responsible for care and maintenance of our bodies/machines

structuralist functionalist paradigm: what is it, whose POV, Parsons sick role, criticisms of sick role?

• Harmonious social system, social roles + institutions (e.g., doctors/patients/clinics)

• Medico-centric (POV of medicine)

• Parsons sick Role: behavioral expectation on how a sick person should act that’s embedded in society

  • Rights:

    • exempt from blame for being ill

    • temporarily exempt from regular roles/responsibilities

  • Duties:

    • Try to get better to resume responsibilities

    • Seek competent help/treatment and cooperate on getting well

  • Criticisms of Sick Role: 

    • Focused on acute illness (rather than chronic)

    • Focused on physical factors (rather than psychosocial)

    • Medico-centric bias (POV of medicine rather than people’s self-care practices like eating healthy or exercise)

    • Doesn’t consider social factors like gender/social class/age

conflict theorist paradigm: what is it, whose POV?

• Who has power, who makes decisions, who decides what’s medically necessary

• Competing interest groups, medical profession = authority

• Medical dominance → profession = power over health care system

• Medical ideology → dominant belief → physicians = authority → health/illness = market value

• Profession of medicine = ultimate authority that determines what disease is

symbolic interactionist paradigm: what is it?

• How people conceptualize health, people’s perspective

• Interactions of individuals, health/illness is socially constructed

feminist paradigm: what is it, whose POV?

• Female POV on historical oppression of women in patriarchy (society with men > women with the use of power)

• Subjective health experiences between men/women

• Androcentric = focus/centered on men (MCQ on Midterm 1)

• Intersectionality gender, social class, ethnicity, age

sociology of the body paradigm: what is it, whose POV?

• We exist in our bodies; we EMBODY societal structures; how does experience of racism get under people’s skin? Ch2/8; embodiment of structure; influences understanding of what society looks like

• Bodies = socially constructed (not just biological)

• Embodiment = human perceptions/experiences through our bodies

• Medical gaze = human body is object of study (focus on symptoms); biopower (power = knowledge over people’s bodies)

self predicted help predicts _________

who dies in population

Ottawa Charter vs individualized health promotion

Ottawa Charter: focus on lifestyle is not everything; social circumstances matter

individualized health promotion: raising health consciousness, health behaviour

upstream vs downstream approach? give an example for each

upstream approaches address the root causes of health issues, while downstream approaches focus on helping people who are already experiencing health problems
ex. downstream focuses on people who already have diabetes, and upstream focuses on how they get diabetes in the first place (for example, provide education to people who are both healthy and at risk)

salutogenic model of health

A conceptual model to provide a guide for identifying and understanding salutary factors that make populations healthy. The model contributes to an improved understanding of the origins of good health and social conditions that facilitate health protective behaviours

salutogenesis

Antonovsky’s term describing the origins of positive health, which was introduced to encourage researchers to pay attention to the factors that protect and enhance good health

what does “prevention paradox say”

• It’s tempting to focus on high risk people but that DOESN’T work

• Majority of cases come from people who are LOW/moderate risk

• Missing vast majority at moderate risk

• Including low/moderate risk people → better chances of reducing cases

5 strategies of the Ottawa Charter, explanations, examples

1. Healthy PUBLIC policy; beyond health care; easiest choice = healthiest choice; all policy makers → some policies make it harder to commit unhealthy behaviours

• (e.g., taxing drugs, smoke-free zones, less tax on low alcohol beer, seatbelts)

2. Create SUPPORTIVE environments; taking care of each other, our communities and natural environment; environments → healthy choices

• (e.g., worksafe initiatives, shaded areas for kids at school, recycling programs, quitline for smokers)

3. Strengthen COMMUNITY action; empowerment of communities; dynamic group of people in common space, identities, interests, concerns; health outcomes determined BY the people

• (e.g., community health centres, community/recreation centres)

4. Build PERSONAL skills; individuals need support to change health; increase available options for more control over health; increase life skills; enable COPING

• (e.g., cooking class = healthy cooking techniques, sports lessons, art/music lessons, extracurriculars/clubs in school)

5. REORIENT Health Care System; shift some of the emphasis in “healthcare” → health promotions; increase attention to health research + changes in professional education and training (go UPSTREAM); curative services → preventative health promotion; avoids biomedical model

• (e.g., doctors incorporating dietary advice during consultations; prescribing exercise programs for treatment of high blood pressure; funding health promotion initiatives out of budget of hospitals)

formula for point prevalence

cases in period - deaths if any - lost if any / total population - deaths if any - lost if any

x100 = %

ex. the point prevalence of the outbreak was _% from day 1-4

formula for period prevalence

total cases in period / total population at start of outbreak

x100 = %

ex. the period prevalence over the entire outbreak was _%

what is sensitivity

the ability of a test to identify a person with a disease as positive; increased sensitivity is indicated by decreasing false negatives

what is specificity

the ability of a test to identify a person without a disease as negative; increased specificity is indicated by decreasing false positives

4 layers of prevention

• Primordial = health education

• Primary = vaccines

• Secondary = screening

• Tertiary = rehabilitation (to prevent further complications of disease)

formula for cumulative incidence

new cases / population at risk at the beginning of the period

x100 = %

Extra notes:

• Too many people in the denominator (i.e., already existing cases, lost, immune) UNDERESTIMATES RISK

• CI is used to estimate the probability (average risk) that a person will DEVELOP the disease during a SPECIFIC time period

Uses

• Quantify the proportion of people with a disease (how many affected)

• Estimate probability that an individual will have the disease during a point in time

• Project healthcare and other policy needs/issues

• Estimate the costs associated with a disease

formula for incidence rate

new cases / person time

endemic

cases are continually occurring in the populationoutbreak of a disease in a localized group of people, spread by:

• Vectors

• Carriers

Sudden intro of new pathogens; more cases than usually expected

epidemic

• outbreak of a disease in a localized group of people, spread by:

  • Vectors

  • Carriers

  • Sudden intro of new pathogens; more cases than usually expected

outbreak

a term used to avoid sensationalism associated with “epidemic”

pandemic

epidemics that have spread beyond their local region and are affecting people in various/all arts of the world

age-standardized rates: what is it and why is it necessary?

• Weighted averages of age-specific rates that are used to modify rates to a standard population

WHY? → different AGE STRUCTURES; some populations are older while some are younger; older populations have more people who are more likely to get sick/die

materialist explanations: explain materialist, differential exposure hypothesis, neo-materialist

Materialist: emphasizes the material conditions under which people live

• Aspects of the social structure (e.g., differences in SES) are powerful determinants of health

• E.g., finances, stress, housing

• Influenced by the political economy perspective of the conflict paradigm

  • Differential Exposure Hypothesis: greater exposure to psychosocial stressors from financial problems, neighborhood issues and social isolation

    • People exposed to positive and negative exposures over the life course and outcomes in adulthood are indicators of advantages and disadvantages & differences in exposure to stress influence biological factors that influence health outcomes

Neo-Materialist: health is affected not only by differential access to social and economic resources; also by the level of funding invested in social infrastructure

• What is the structure/funding in the structure? infrastructure, libraries; how materialist stuff happens

cultural behavioural explanations: cultural behavioural, differential vulnerability hypothesis and its assumption

• Cultural Behavioural: poor health is a result of bad coping

• Differential Vulnerability Hypothesis: all have stressors; position in social gradient can make some worse than others; how we learn to behave in society

  • Lower-SES individuals are less healthy as a result of engaging in health-related behaviours such as smoking or poor eating habits

  • Assumption: these individuals don’t cope very well with environmental stressors and therefore, experience worse health

psychosocial explanations: psychosocial, social comparison

• Psychosocial: comparing self to others; inequities (last part of Ch5 = MCQ)

  • People’s interpretation of their standing in the social hierarchy matters

  • Sense of relative deprivation can generate feelings of low self-esteem, shame, and envy

  • Strive and fail = consequences

    • Social Comparison: not material factors per se, but perception and understanding of where people are in social structure; perception of hierarchy leads to stress comparisons lead t shame, envy, other mental health outcomes and/or other negative behaviours

list the 4 hypotheses for why gender matters and explain one in depth

Risk Taking Hypothesis

• Men are more socialized to take risks

  • Men engage in more risky behaviour 

• Women are socialized to be more cautious / concerned for their health

  • Women engage in protective behaviour (seek treatment + self-care)

• Hegemonic Masculinity: the culturally dominant idea of what it means to be male and how masculine men are supposed to behave within patriarchal society

Role Accumulation Hypothesis

• More roles result in better health because they provide more benefits (greater self-esteem, life satisfaction, sources of social support, improved financial resources)

• E.g., women having 3 roles (wife, mother, worker)

  • Wife → social/financial support from husband/marriage

  • Mother → financial support allows to provide for children

  • Worker → independence/increased self-esteem, income to provide for kids

Role Strain Hypothesis

• Harmful effects of women’s roles 

• Women with multiple roles = overload and role conflict

  • Trying to live up to nurturing expectations of being a mother/wife and keeping up with work can lead to experienced stress in women because they end up ignoring their own health

• Increased stress and excessive demands → increased psychological distress/worse health for women

Social Acceptability Hypothesis

Women

• Socialization into patriarchal gender roles → women are more willing to adopt the sick role (admit being sick and accept help related to health problems)

• Women more likely to to report experiencing symptoms → Women have more of a tendency to seek help → more likely to get diagnosis

Men

• Men socialized to deny that they are experiencing symptoms of illness

• Reluctant to adopt the sick role

• Reluctant to seek help for health problems (until their symptoms become impossible to ignore)

• ***Women admit to experiencing more ill health but may live longer than men because they are willing to take health action and seek early treatment

Healthy Immigrant Effect

• first 10 years they have better health, but then deteriorate

  • Culturation; e.g., become like other Canadians

  • Resettlement stress (most evidence)

  • Healthcare

list 5 ways that we measure health

1. Levels of cortisol

2. Index of life events

3. Perceived stress score

4. Biological markers of stress → allostatic load

5. Mental health as a measure of stress (e.g., measures of depression)

how do we target/reduce stress?

• Focus on mental health resources

• Individualized ways to manage stress vs. structural approaches (e.g., not having exams at 10pm; make students lives better; students are stressed about tuition fees)

name 2 explanations for why work matters and describe

• Demand control; describe

  • Two Dimensions:

    • Psychological demands on the working person

    • Degree of control the person has over work schedules and job conditions

  • High demand + high support = ACTIVE (active learning, motivation)

  • Low demand + low control = PASSIVE

  • High demand + low control = HIGH strain (risk of psychological strain and physical illness)

  • Low demand + high control = LOW strain

• Effort reward imbalance; describe

  • Emphasizes the importance of social reciprocity (give/take) in our work lives

  • Time/effort doesn’t match rewards (income, job security, esteem)

    • Leads to negative health effects

  • This model shows how modern work is structured (competitive wages, high work pressure, low job security, lack of self esteem)

  • Depicts how work stress has negative health effects due to its wide application in international studies

  • “Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease independent of any job strain experienced”

To be a member of the top 1% of Canadian income earners in 2020, you needed a total income of

$512,000

The median income of Canadians in 2020 was

$54,200

Income inequality hypothesis and the issues with it

Income inequality hypothesis: greater inequality in income distribution within a population increases social problems, including a social gradient of health

Issues with Income Inequality Hypothesis

• Aggregate vs. Individual Level Measurement

  • Effect of within-country or community area policies?

  • Timing of inequality and onset of health issues

  • Effect of average income level of country

  • Mechanisms

6 features of Canadian health care

• Healthcare delivery is a PROVINCIAL responsibility

• Healthcare is privately delivered and publicly financed

• Private providers and public not-for-profit hospitals

• Fee for service funding and global budgets

• Choice of practitioner

• Universal coverage applies to less than ½ of total health care expenditures

RAND Health Insurance Experiment: what was it, what was the outcome

• RAND Health Insurance Experiment = the more patients had to pay for care, the less they used

  • Less care → lower costs

    • Didn’t lead to greater efficiency; sometimes people received fewer services when they actually needed more

  • Proportion of inappropriate hospital stays/admissions

• User fees lowered the appropriate use of effective preventative services/medications to manage chronic diseases

  • User fees have also reduced inappropriate as well as appropriate antibiotic use too a similar extent

  • User fees reduced the annual use of physician services by ~6%

  • Low-income families reduced their use of physician services by about 18%

  • Saskatchewan: physician fees increased; high-income earners on average increased their use of physician services

  • User fees can cause people to get necessary treatment; e.g., having to pay user fees → took less medicine and condition worsened → more visits to emergency departments

  • Study: raising user fees for physician

top 3 leading causes of death in North America in 1990s

(1) pneumonia (2) tuberculosis (3) diarrhea

leading causes of death in Canada in 2019

(1) cancer (2) other causes (3) heart disease

leading causes of death in Canada in 2020

(1) malignant neoplasms (2) heart disease (3) COVID-19

Hegemonic Masculinity

the culturally dominant idea of what it means to be male and how masculine men are supposed to behave within patriarchal society

Androcentric

a way of thinking that privileges the masculine perspective when trying to understand social life

Iatrogenesis

sickness/injury caused by the healthcare system

Neoliberalism

• political philosophy about free market, how things operate in society

  • You need to educate people → people would make better choices

what does cumulative incidence exclude and why

excludes people who already have the disease, who cannot develop the disease in order to avoid underestimating risk

what does incidence rate measure

the rate of development of a disease in a population (true rate)

personal determinants of health (4)

• Genetic makeup

• Lay health beliefs

• Self-health management (self-care capacity, coping skills)

• Health protective behaviours (personal health practices, healthy lifestyles)

structural determinants of health (4)

• Social environment (socioeconomic status, gender/ethnicity/age, social support)

• Health-care services (disease prevention, health promotion)

• Income distribution

• Living/working conditions

horizontal structures

• Immediate factors that shape health and well-being

  • E.g., family environment, nature of work and workplace conditions, quality of housing, neighborhood resources

vertical structures

• Macro-level factors that indirectly influence health and well-being

• social/political/economic policies regarding social welfare and taxation

• vertical structures determine the quality of horizontal structures

structural agency issue

sociological concept that explores the tension between individual autonomy (agency) and the constraints imposed by social structures when analyzing behaviors and outcomes. In the context of health beliefs, behaviors, and inequities, this issue helps explain how individuals make health-related choices and how those choices are influenced or restricted by broader social factors.

who proved the true cause of pellagra?

Joseph Goldberger

who is best known for his work on stress (developing general adaptation syndrome model)

Hans Selye

social gradient

describes the stepwise relationship between socioeconomic position and health, where each step up in social status is associated with better health outcomes, and each step down corresponds to worse outcomes